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Derkenne C, Frattini B, Menetre S, Hong Tuan Ha V, Lemoine F, Beganton F, Didon JP, Rozenberg E, Salome M, Trichereau J, Corcostegui SP, Lemoine S, Kedzierewicz R, Burlaton G, Vial V, Dessertaine T, Miron De L'Espinay A, Jouven X, Travers S, Jost D. Analysis during chest compressions in out-of-hospital cardiac arrest patients, a cross/sectional study: The DEFI 2022 study. Resuscitation 2024:110292. [PMID: 38909837 DOI: 10.1016/j.resuscitation.2024.110292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/13/2024] [Accepted: 06/15/2024] [Indexed: 06/25/2024]
Abstract
AIMS During out-of-hospital cardiac arrest (OHCA), an automatic external defibrillator (AED) analyzes the cardiac rhythm every two minutes; however, 80% of refibrillations occur within the first minute post-shock. We have implemented an algorithm for Analyzing cardiac rhythm While performing chest Compression (AWC). When AWC detects a shockable rhythm, it shortens the time between analyses to one minute. We investigated the effect of AWC on cardiopulmonary resuscitation quality. METHOD In this cross-sectional study, we compared patients treated in 2022 with AWC, to a historical cohort from 2017. Inclusion criteria were OHCA patients with a shockable rhythm at the first analysis. Primary endpoint was the chest compression fraction (CCF). Secondary endpoints were cardiac rhythm evolution and survival, including survival analysis of non-prespecified subgroups. RESULTS In 2017 and 2022, 355 and 377 OHCAs met the inclusion criteria, from which we analyzed the 285 first consecutive cases in each cohort. CCF increased in 2022 compared to 2017 (77% [72-80] vs 72% [67-76]; P < 0.001) and VF recurrences were shocked more promptly (53 s [32-69] vs 117 s [90-132]). Survival did not differ between 2017 and 2022 (adjusted hazard-ratio 0.96 [95% CI, 0.78-1.18]), but was higher in 2022 within the sub-group of OHCAs that occurred in a public place and within a short time from call to AED switch-on (adjusted hazard ratio 0.85[0.76-0.96]). CONCLUSIONS OHCA patients treated with AWC had higher CCF, shorter time spent in ventricular fibrillation, but no survival difference, except for OHCA that occurred in public places with short intervention time.
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Affiliation(s)
| | - Benoit Frattini
- Paris Fire Brigade, 1 place Jules Renard, 75017 Paris, France
| | - Sarah Menetre
- Schiller Medical SAS, 4 rue L. Pasteur, F-67160 Wissembourg, France
| | | | | | | | | | | | - Marina Salome
- Paris Fire Brigade, 1 place Jules Renard, 75017 Paris, France
| | | | | | - Sabine Lemoine
- Paris Fire Brigade, 1 place Jules Renard, 75017 Paris, France
| | | | | | - Valentin Vial
- Paris Fire Brigade, 1 place Jules Renard, 75017 Paris, France
| | | | | | - Xavier Jouven
- Sudden Death Expertise Center, INSERM U970, Paris, France
| | | | - Daniel Jost
- Paris Fire Brigade, 1 place Jules Renard, 75017 Paris, France
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2
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Lauridsen KG, Morgan RW, Berg RA, Niles DE, Kleinman ME, Zhang X, Griffis H, Del Castillo J, Skellett S, Lasa JJ, Raymond TT, Sutton RM, Nadkarni VM. Association Between Chest Compression Pause Duration and Survival After Pediatric In-Hospital Cardiac Arrest. Circulation 2024; 149:1493-1500. [PMID: 38563137 PMCID: PMC11073898 DOI: 10.1161/circulationaha.123.066882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest survival outcomes is unknown. The American Heart Association has recommended minimizing pauses in CC in children to <10 seconds, without supportive evidence. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurological outcomes. METHODS In this cohort study of index pediatric in-hospital cardiac arrests reported in pediRES-Q (Quality of Pediatric Resuscitation in a Multicenter Collaborative) from July of 2015 through December of 2021, we analyzed the association in 5-second increments of the longest CC pause duration for each event with survival and favorable neurological outcome (Pediatric Cerebral Performance Category ≤3 or no change from baseline). Secondary exposures included having any pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds per 2 minutes. RESULTS We identified 562 index in-hospital cardiac arrests (median [Q1, Q3] age 2.9 years [0.6, 10.0], 43% female, 13% shockable rhythm). Median length of the longest CC pause for each event was 29.8 seconds (11.5, 63.1). After adjustment for confounders, each 5-second increment in the longest CC pause duration was associated with a 3% lower relative risk of survival with favorable neurological outcome (adjusted risk ratio, 0.97 [95% CI, 0.95-0.99]; P=0.02). Longest CC pause duration was also associated with survival to hospital discharge (adjusted risk ratio, 0.98 [95% CI, 0.96-0.99]; P=0.01) and return of spontaneous circulation (adjusted risk ratio, 0.93 [95% CI, 0.91-0.94]; P<0.001). Secondary outcomes of any pause >10 seconds or >20 seconds and number of CC pauses >10 seconds and >20 seconds were each significantly associated with adjusted risk ratio of return of spontaneous circulation, but not survival or neurological outcomes. CONCLUSIONS Each 5-second increment in longest CC pause duration during pediatric in-hospital cardiac arrest was associated with lower chance of survival with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation. Any CC pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds were significantly associated with lower adjusted probability of return of spontaneous circulation, but not survival or neurological outcomes.
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Affiliation(s)
- Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University, Denmark (K.G.L.)
- Department of Anesthesiology and Critical Care Medicine, Randers Regional Hospital, Denmark (K.G.L.)
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
| | - Dana E Niles
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
| | - Monica E Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, MA (M.E.K.)
| | - Xuemei Zhang
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, PA (X.Z., H.G.)
| | - Heather Griffis
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, PA (X.Z., H.G.)
| | - Jimena Del Castillo
- Department of Pediatric Intensive Care, Hospital Maternoinfantil Gregorio Marañón, Madrid, Spain (J.D.C.)
| | - Sophie Skellett
- Department of Critical Care Medicine, Great Ormond Street Hospital for Children, London, England (S.S.)
| | - Javier J Lasa
- Divisions of Cardiology and Critical Care Medicine, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX (J.J.L.)
| | - Tia T Raymond
- Department of Pediatrics, Cardiac Intensive Care, Medical City Children's Hospital, Dallas, TX (T.T.R.)
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
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3
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Meilandt C, Qvortrup M, Bøtker MT, Folke F, Borup L, Christensen HC, Milling L, Lauridsen KG, Løfgren B. Association Between Defibrillation Using LIFEPAK 15 or ZOLL X Series and Survival Outcomes in Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study. J Am Heart Assoc 2024; 13:e033913. [PMID: 38533945 PMCID: PMC11179748 DOI: 10.1161/jaha.123.033913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Defibrillation is essential for achieving return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) with shockable rhythms. This study aimed to investigate if the type of defibrillator used was associated with ROSC in OHCA. METHODS AND RESULTS This study included adult patients with OHCA from the Danish Cardiac Arrest Registry from 2016 to 2021 with at least 1 defibrillation by the emergency medical services. We used multivariable logistic regression and a difference-in-difference analysis, including all patients with or without emergency medical services shock to assess the causal inference of using the different defibrillator models (LIFEPAK or ZOLL) for OHCA defibrillation. Among 6516 patients, 77% were male, the median age (quartile 1; quartile 3) was 70 (59; 79), and 57% achieved ROSC. In total, 5514 patients (85%) were defibrillated using LIFEPAK (ROSC: 56%) and 1002 patients (15%) were defibrillated using ZOLL (ROSC: 63%). Patients defibrillated using ZOLL had an increased adjusted odds ratio (aOR) for ROSC compared with LIFEPAK (aOR, 1.22 [95% CI, 1.04-1.43]). There was no significant difference in 30-day mortality (aOR, 1.11 [95% CI, 0.95-1.30]). Patients without emergency medical services defibrillation, but treated by ZOLL-equipped emergency medical services, had a nonsignificant aOR for ROSC compared with LIFEPAK (aOR, 1.10 [95% CI, 0.99-1.23]) and the difference-in-difference analysis was not statistically significant (OR, 1.10 [95% CI, 0.91-1.34]). CONCLUSIONS Defibrillation using ZOLL X Series was associated with increased odds for ROSC compared with defibrillation using LIFEPAK 15 for patients with OHCA. However, a difference-in-difference analysis suggested that other factors may be responsible for the observed association.
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Affiliation(s)
- Carsten Meilandt
- Prehospital Emergency Medical Services, Central Denmark RegionAarhusDenmark
- Department of Research and DevelopmentPrehospital Emergency Medical Services, Central Denmark RegionAarhusDenmark
| | - Mette Qvortrup
- Department of CardiologyViborg Regional HospitalViborgDenmark
| | - Morten Thingemann Bøtker
- Prehospital Emergency Medical Services, Central Denmark RegionAarhusDenmark
- Department of Research and DevelopmentPrehospital Emergency Medical Services, Central Denmark RegionAarhusDenmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Capital Region of DenmarkCopenhagenDenmark
- Department of CardiologyHerlev Gentofte University HospitalHerlevDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Lars Borup
- Prehospital Emergency Medical Services, North Denmark RegionAalborgDenmark
| | | | - Louise Milling
- The Prehospital Research Unit, Region of Southern DenmarkOdenseDenmark
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Kasper G. Lauridsen
- Research Center for Emergency MedicineAarhus UniversityAarhusDenmark
- Department of MedicineRanders Regional HospitalRandersDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Bo Løfgren
- Research Center for Emergency MedicineAarhus UniversityAarhusDenmark
- Department of MedicineRanders Regional HospitalRandersDenmark
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Magliocca A, Castagna V, Fornari C, Zimei G, Merigo G, Penna A, Carlson J, Fumagalli F, Stirparo G, Migliari M, Coppo A, Sechi GM, Grasselli G, Hardig BM, Ristagno G. Transthoracic impedance variability to assess quality of chest compression in out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2024; 68:556-566. [PMID: 38221650 DOI: 10.1111/aas.14374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/20/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Chest compression is a lifesaving intervention in out-of-hospital cardiac arrest (OHCA), but the optimal metrics to assess its quality have yet to be identified. The objective of this study was to investigate whether a new parameter, that is, the variability of the chest compression-generated transthoracic impedance (TTI), namely ImpCC , which measures the consistency of the chest compression maneuver, relates to resuscitation outcome. METHODS This multicenter observational, retrospective study included OHCAs with shockable rhythm. ImpCC variability was evaluated with the power spectral density analysis of the TTI. Multivariate regression model was used to examine the impact of ImpCC variability on defibrillation success. Secondary outcome measures were return of spontaneous circulation and survival. RESULTS Among 835 treated OHCAs, 680 met inclusion criteria and 565 matched long-term outcomes. ImpCC was significantly higher in patients with unsuccessful defibrillation compared to those with successful defibrillation (p = .0002). Lower ImpCC variability was associated with successful defibrillation with an odds ratio (OR) of 0.993 (95% confidence interval [95% CI], 0.989-0.998, p = .003), while the standard chest compression fraction (CCF) was not associated (OR 1.008 [95 % CI, 0.992-1.026, p = .33]). Neither ImpCC nor CCF was associated with long-term outcomes. CONCLUSIONS In this population, consistency of chest compression maneuver, measured by variability in TTI, was an independent predictor of defibrillation outcome. ImpCC may be a useful novel metrics for improving quality of care in OHCA.
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Affiliation(s)
- Aurora Magliocca
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Valentina Castagna
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carla Fornari
- Research Centre on Public Health, University of Milano-Bicocca, Monza, Italy
| | - Gabriele Zimei
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Merigo
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Penna
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jonas Carlson
- Clinical Sciences, Helsingborg, Medical Faculty, Lund University, Helsingborg, Sweden
| | - Francesca Fumagalli
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | | | - Anna Coppo
- Agenzia Regionale Emergenza Urgenza, Milan, Italy
| | | | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bjarne Madsen Hardig
- Clinical Sciences, Helsingborg, Medical Faculty, Lund University, Helsingborg, Sweden
| | - Giuseppe Ristagno
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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5
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Ciullo AL, Tonna JE. The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going? J Am Coll Emerg Physicians Open 2024; 5:e13101. [PMID: 38260003 PMCID: PMC10800292 DOI: 10.1002/emp2.13101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged in the context of the emergency department as a life-saving therapy for patients with refractory cardiac arrest. This review examines the utility of ECPR based on current evidence gleaned from three pivotal trials: the ARREST trial, the Prague study, and the INCEPTION trial. We also discuss several considerations in the care of these complex patients, including prehospital strategy, patient selection, and postcardiac arrest management. Collectively, the evidence from these trials emphasizes the growing significance of ECPR as a viable intervention, highlighting its potential for improved outcomes and survival rates in patients with refractory cardiac arrest when employed judiciously. As such, these findings advocate the need for further research and protocol development to optimize its use in diverse clinical scenarios.
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Affiliation(s)
- Anna L. Ciullo
- Division of Cardiothoracic SurgeryDepartment of SurgeryUniversity of Utah HealthSalt Lake CityUtahUSA
- Division of Emergency MedicineDepartment of SurgeryUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Joseph E. Tonna
- Division of Cardiothoracic SurgeryDepartment of SurgeryUniversity of Utah HealthSalt Lake CityUtahUSA
- Division of Emergency MedicineDepartment of SurgeryUniversity of Utah HealthSalt Lake CityUtahUSA
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6
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Voizard P, Vincelette C, Carrier FM, Sokoloff C. Residual Psychomotor Skills of Orderlies After a Novel Chest Compression Training Intervention. Am J Crit Care 2023; 32:381-386. [PMID: 37652877 DOI: 10.4037/ajcc2023772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND High-quality chest compressions are essential to favorable patient outcomes after in-hospital cardiac arrest. Without frequent training, however, skill in performing compressions declines considerably. The Timely Chest Compression Training (T-CCT) intervention was introduced in 2019 as a quality improvement initiative to address this problem. The long-term impact of the T-CCT is unknown. METHODS A cohort study was conducted at a university-affiliated hospital in Quebec, Canada. Chest compression performance among orderlies was measured by using a subtractive scoring model and mannequins. The association of exposure to the T-CCT 10 months earlier with having an excellent chest compression performance (score ≥90 out of 100), after adjusting for potential confounders, was examined. RESULTS A total of 412 orderlies participated in the study. More than half (n = 232, 56%) had been exposed to the T-CCT, and the rest (n = 180, 44%) had not. Nearly half (n = 106, 46%) of orderlies exposed to the T-CCT had an excellent performance, compared with less than one-third (n = 53, 30%) of nonexposed orderlies. In univariable analysis, previous exposure to the T-CCT was associated with 1.53 times greater risk of having an excellent performance (risk ratio, 1.53; 95% CI, 1.17-1.99). This effect remained after adjustment for potential confounders (risk ratio, 1.57; 95% CI, 1.19-2.07). CONCLUSION The results of this study suggest that the T-CCT has a lasting effect on the psychomotor skills of orderlies 10 months after initial exposure. Further research should investigate the impact of the intervention on patient outcomes after in-hospital cardiac arrest.
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Affiliation(s)
- Philippe Voizard
- Philippe Voizard is an emergency medicine resident, Department of Emergency Medicine and Family Medicine, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Christian Vincelette
- Christian Vincelette is a postdoctoral researcher, CHUM (Centre hospitalier de l'Université de Montréal) Research Centre, Montreal, Canada
| | - François Martin Carrier
- François Martin Carrier is a physician, Department of Anaesthesiology and Pain Medicine and Department of Medicine-Critical Care Division, CHUM; and a researcher, Health Innovation and Evaluation Hub, CHUM Research Centre
| | - Catalina Sokoloff
- Catalina Sokoloff is a physician, Department of Emergency and Family Medicine and Department of Medicine-Critical Care Division, CHUM; a contributor, Learning and Simulation Center, CHUM Academy, Montreal, Canada; and a researcher, CHUM Research Centre
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7
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar J, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Pediatrics 2023; 151:189896. [PMID: 36325925 DOI: 10.1542/peds.2022-060463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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8
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Ong YKG, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM, Cartledge S, Dawson JA, Elgohary MM, Ersdal HL, Finan E, Flaatten HI, Flores GE, Fuerch J, Garg R, Gately C, Goh M, Halamek LP, Handley AJ, Hatanaka T, Hoover A, Issa M, Johnson S, Kamlin CO, Ko YC, Kule A, Leone TA, MacKenzie E, Macneil F, Montgomery W, O’Dochartaigh D, Ohshimo S, Palazzo FS, Picard C, Quek BH, Raitt J, Ramaswamy VV, Scapigliati A, Shah BA, Stewart C, Strand ML, Szyld E, Thio M, Topjian AA, Udaeta E, Vaillancourt C, Wetsch WA, Wigginton J, Yamada NK, Yao S, Zace D, Zelop CM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2022; 146:e483-e557. [PMID: 36325905 DOI: 10.1161/cir.0000000000001095] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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9
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2022; 181:208-288. [PMID: 36336195 DOI: 10.1016/j.resuscitation.2022.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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10
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Lauridsen KG, Lasa JJ, Raymond TT, Yu P, Niles D, Sutton RM, Morgan RW, Fran Hazinski M, Griffis H, Hanna R, Zhang X, Berg RA, Nadkarni VM. Association of Chest Compression Pause Duration Prior to E-CPR Cannulation with Cardiac Arrest Survival Outcomes. Resuscitation 2022; 177:85-92. [PMID: 35588971 DOI: 10.1016/j.resuscitation.2022.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To characterize chest compression (CC) pause duration during the last 5 minutes of pediatric cardiopulmonary resuscitation (CPR) prior to extracorporeal-CPR (E-CPR) cannulation and the association with survival outcomes. METHODS Cohort study from a resuscitation quality collaborative including pediatric E-CPR cardiac arrest events ≥10 min with CPR quality data. We characterized CC interruptions during the last 5 min of defibrillator-electrode recorded CPR (prior to cannulation) and assessed the association between the longest CC pause duration and survival outcomes using multivariable logistic regression. RESULTS Of 49 E-CPR events, median age was 2.0 [Q1, Q3: 0.6, 6.6] years, 55% (27/49) survived to hospital discharge and 18/49 (37%) with favorable neurological outcome. Median duration of CPR was 51 [43, 69] min. During the last 5 min of recorded CPR prior to cannulation, median duration of the longest CC pause was 14.0 [6.3, 29.4] sec: 66% >10 sec, 25% >29 sec, 14% >60 sec, and longest pause 168 sec. Following planned adjustment for known confounders of age and CPR duration, each 5-sec increase in longest CC pause duration was associated with lower odds of survival to hospital discharge [adjusted OR 0.89, 95%CI: 0.79-0.99] and lower odds of survival with favorable neurological outcome [adjusted OR 0.77, 95%CI: 0.60-0.98]. CONCLUSIONS Long CC pauses were common during the last 5 min of recorded CPR prior to E-CPR cannulation. Following adjustment for age and CPR duration, each 5-second incremental increase in longest CC pause duration was associated with significantly decreased rates of survival and favorable neurological outcome.
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Affiliation(s)
- Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Emergency Department, Randers Regional Hospital, Randers, Denmark; Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA.
| | - Javier J Lasa
- Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, USA
| | - Tia T Raymond
- Department of Pediatrics, Cardiac Intensive Care, Medical City Children's Hospital, Dallas, USA
| | - Priscilla Yu
- Dept of Pediatrics, Division of Critical Care Medicine, UT Southwestern Medical Center, Dallas, USA
| | - Dana Niles
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Robert M Sutton
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Ryan W Morgan
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Mary Fran Hazinski
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Richard Hanna
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Xuemei Zhang
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Robert A Berg
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Vinay M Nadkarni
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
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11
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Loza-Gomez A, Johnson M, Newby M, LeGassick T, Larmon B. Chest Compression Fraction Alone Does Not Adequately Measure Cardiopulmonary Resuscitation Quality in Out-of-Hospital Cardiac Arrest. J Emerg Med 2022; 62:e35-e43. [PMID: 35058094 DOI: 10.1016/j.jemermed.2021.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND High-quality cardiopulmonary resuscitation in out-of-hospital cardiac arrest is important for increased survival and improved neurological outcome. Chest compression fraction measures the proportion of time chest compressions are given during a cardiac arrest resuscitation. Chest compression fraction has not been compared with the quality of chest compressions delivered at the recommended rate and depth of 100-120/min and 2.0-2.4 inches, respectively. OBJECTIVES We evaluate whether chest compression fraction correlates with compressions at a target rate of 100-120/min and depth of 2.0-2.4 inches in chest diameter. METHODS A prospective, observational study design was used to compare chest compression fraction to compressions in target in out-of-hospital cardiac arrest patients in a prehospital urban setting. We include all adult, non-traumatic out-of-hospital cardiac arrest patients with a resuscitation attempt during January 1, 2019 through September 30, 2019, for a total of 9 months. Spearman's rank correlation was used to determine correlation between compression fraction and compressions in target. RESULTS A total of 120 out-of-hospital cardiac arrest cases were included in the study. We found a high chest compression fraction median of 83% (interquartile range 72-90%), but a low compression in target median of 13% (interquartile range 5-29%). There was no significant correlation between chest compression fraction and compressions in target when analyzed linearly (Spearman's Rho = 0.165, p = 0.072). No difference was found when dichotomizing chest compression fraction into high and low variables in comparison with compressions in target (14% vs. 10%, p = 0.119). CONCLUSION Chest compression fraction is not associated with compressions in target for rate and depth for out-of-hospital cardiac arrest cardiopulmonary resuscitation.
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Affiliation(s)
- Angelica Loza-Gomez
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Megan Johnson
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Marianne Newby
- Center for Prehospital Care, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Todd LeGassick
- Center for Prehospital Care, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Baxter Larmon
- Center for Prehospital Care, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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12
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Effect of Early Supraglottic Airway Device Insertion on Chest Compression Fraction during Simulated Out-of-Hospital Cardiac Arrest: Randomised Controlled Trial. J Clin Med 2021; 11:jcm11010217. [PMID: 35011958 PMCID: PMC8745715 DOI: 10.3390/jcm11010217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 12/31/2022] Open
Abstract
Early insertion of a supraglottic airway (SGA) device could improve chest compression fraction by allowing providers to perform continuous chest compressions or by shortening the interruptions needed to deliver ventilations. SGA devices do not require the same expertise as endotracheal intubation. This study aimed to determine whether the immediate insertion of an i-gel® while providing continuous chest compressions with asynchronous ventilations could generate higher CCFs than the standard 30:2 approach using a face-mask in a simulation of out-of-hospital cardiac arrest. A multicentre, parallel, randomised, superiority, simulation study was carried out. The primary outcome was the difference in CCF during the first two minutes of resuscitation. Overall and per-cycle CCF quality of compressions and ventilations parameters were also compared. Among thirteen teams of two participants, the early insertion of an i-gel® resulted in higher CCFs during the first two minutes (89.0% vs. 83.6%, p = 0.001). Overall and per-cycle CCF were consistently higher in the i-gel® group, even after the 30:2 alternation had been resumed. In the i-gel® group, ventilation parameters were enhanced, but compressions were significantly shallower (4.6 cm vs. 5.2 cm, p = 0.007). This latter issue must be addressed before clinical trials can be considered.
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13
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Vestergaard LD, Lauridsen KG, Krarup NHV, Kristensen JU, Andersen LK, Løfgren B. Quality of Cardiopulmonary Resuscitation and 5-Year Survival Following in-Hospital Cardiac Arrest. Open Access Emerg Med 2021; 13:553-560. [PMID: 34938129 PMCID: PMC8687881 DOI: 10.2147/oaem.s341479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/03/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose To improve cardiac arrest survival, international resuscitation guidelines emphasize measuring the quality of cardiopulmonary resuscitation (CPR). We aimed to investigate CPR quality during in-hospital cardiac arrest (IHCA) and study long-term survival outcomes. Patients and Methods This was a cohort study of IHCA from December 2011 until November 2014. Data were collected from the hospital switch board, patient records, and from defibrillators. Impedance data from defibrillators were analyzed manually at the level of single compressions. Long-term survival at 1-, 3-, and 5 years is reported. Results The study included 189 IHCAs; median (interquartile range (IQR)) time to first rhythm analysis was 116 (70-201) seconds and median (IQR) time to first defibrillation was 133 (82-264) seconds. Median (IQR) chest compression rate was 126 (119-131) per minute and chest compression fraction (CCF) was 78% (69-86). Thirty-day survival was 25%, while 1-year-, 3-year-, and 5-year survival were 21%, 14%, and 13%, respectively. There was no significant association between any survival outcomes and CCF, whereas chest compression rate was associated with survival to 30 days and 3 years. Overall, 5-year survival was associated with younger age (median 68 vs 74 years, p=0.003), less comorbidity (Charlson comorbidity index median 3 vs 5, p<0.001), and witnessed cardiac arrest (96% vs 77%, p=0.03). Conclusion We established a systematic collection of IHCA CPR quality data to measure and improve CPR quality and long-term survival outcomes. Median time to first rhythm check/defibrillation was <3 minutes, but median chest compression rate was too fast and median CCF slightly below 80%. More than half of 30-day survivors were still alive at 5 years.
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Affiliation(s)
| | - Kasper Glerup Lauridsen
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Bo Løfgren
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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14
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Meng XY, You J, Dai LL, Yin XD, Xu JA, Wang JF. Efficacy of a Simplified Feedback Trainer for High-Quality Chest Compression Training: A Randomized Controlled Simulation Study. Front Public Health 2021; 9:675487. [PMID: 34722430 PMCID: PMC8551574 DOI: 10.3389/fpubh.2021.675487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The most recent international guidelines recommended support training of chest compression (CC) using feedback devices. This study aimed to compare the training efficacy of a simplified feedback trainer with the traditional cardiopulmonary resuscitation (CPR) simulator in CPR training. Methods: A total of 60 soldiers were randomly allocated into three groups equally, trained with a simplified external cardiac massage (ECM) trainer named Soul SheathTM (SS) (SS group), a Resusci Anne manikin (RA group), or traditional simulation training with instructor feedback, respectively. After 7 days of training, the CPR skills were tested blindly in a 2-min assessment session. The primary outcome was the proportion of effective CC, and the secondary outcome included CC rate, depth, compression position, and extent of the release. Results: The percentage of effective CC achieved in the SS group was comparable with the RA group (77.0 ± 15.52 vs. 77.5 ± 10.73%, p = 0.922), and significantly higher than that in the control group (77.0 ± 15.52 vs. 66.8 ± 16.87%, p = 0.037). Both the SS and RA groups showed better CC performance than the control group in terms of CC rate (SS group vs. control group, P = 0.032 and RA group vs. control group, P = 0.026), the proportion of shallow CC (SS group vs. control group, P = 0.011 and RA group vs. control group, P = 0.017). No difference between the SS group and RA group was found in all the CC parameters. Conclusions: The simplified ECM trainer (SS) provides a similar efficacy to the traditional manikin simulator with feedback in CC training to improve the quality of CPR skills.
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Affiliation(s)
- Xiao-yan Meng
- Department of Anesthesiology, Eastern Hepatobiliary Surgical Hospital, Naval Medical University, Shanghai, China
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jia You
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Li-li Dai
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiao-dong Yin
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jian-an Xu
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jia-feng Wang
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
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15
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Stuby L, Jampen L, Sierro J, Paus E, Spichiger T, Suppan L, Thurre D. Effect on Chest Compression Fraction of Continuous Manual Compressions with Asynchronous Ventilations Using an i-gel ® versus 30:2 Approach during Simulated Out-of-Hospital Cardiac Arrest: Protocol for a Manikin Multicenter Randomized Controlled Trial. Healthcare (Basel) 2021; 9:354. [PMID: 33804664 PMCID: PMC8003743 DOI: 10.3390/healthcare9030354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/30/2022] Open
Abstract
The optimal airway management strategy during cardiopulmonary resuscitation is uncertain. In the case of out-of-hospital cardiac arrest, a high chest compression fraction is paramount to obtain the return of spontaneous circulation and improve survival and neurological outcomes. To improve this fraction, providing continuous chest compressions should be more effective than using the conventional 30:2 ratio. Airway management should, however, be adapted, since face-mask ventilation can hardly be carried out while continuous compressions are administered. The early insertion of a supraglottic device could therefore improve the chest compression fraction by allowing ventilation while maintaining compressions. This is a protocol for a multicenter, parallel, randomized simulation study. Depending on randomization, each team made up of paramedics and emergency medical technicians will manage the 10-min scenario according either to the standard approach (30 compressions with two face-mask ventilations) or to the experimental approach (continuous manual compressions with early insertion of an i-gel® supraglottic device to deliver asynchronous ventilations). The primary outcome will be the chest compression fraction during the first two minutes of cardiopulmonary resuscitation. Secondary outcomes will be chest compression fraction (per cycle and overall), compressions and ventilations quality, time to first shock and to first ventilation, user satisfaction, and providers' self-assessed cognitive load.
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Affiliation(s)
- Loric Stuby
- Genève TEAM Ambulances, Emergency Medical Services, CH-1201 Geneva, Switzerland;
| | - Laurent Jampen
- ESAMB—École Supérieure de Soins Ambulanciers, College of Higher Education in Ambulance Care, CH-1231 Conches, Switzerland;
| | - Julien Sierro
- Compagnie d’Ambulances de l’Hôpital du Valais, Emergency Medical Services, CH-1920 Martigny, Switzerland;
| | - Erik Paus
- SPSL—Service de Protection et Sauvetage Lausanne, Emergency Medical Services, CH-1005 Lausanne, Switzerland;
| | - Thierry Spichiger
- ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, CH-1052 Le Mont-sur-Lausanne, Switzerland;
- Ambulance Riviera, Association Sécurité Riviera, Emergency Medical Services, CH-1814 La Tour-de-Peilz, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, CH-1211 Geneva, Switzerland;
| | - David Thurre
- Genève TEAM Ambulances, Emergency Medical Services, CH-1201 Geneva, Switzerland;
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16
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Tisch CF, Abella BS. What gaps in chest compressions tell us about gaps in CPR knowledge. Resuscitation 2020; 154:119-120. [PMID: 32707145 DOI: 10.1016/j.resuscitation.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Charlotte F Tisch
- Center for Resuscitation Science and Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, US
| | - Benjamin S Abella
- Center for Resuscitation Science and Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, US.
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Buléon C, Parienti JJ, Morilland-Lecoq E, Halbout L, Cesaréo E, Dubien PY, Jardel B, Boyer C, Husson K, Andriamirado F, Benet X, Morel-Marechal E, Aubrion A, Muntean C, Dupire E, Roupie E, Hubert H, Vilhelm C, Gueugniaud PY. Impacts of chest compression cycle length and real-time feedback with a CPRmeter® on chest compression quality in out-of-hospital cardiac arrest: study protocol for a multicenter randomized controlled factorial plan trial. Trials 2020; 21:627. [PMID: 32641090 PMCID: PMC7346361 DOI: 10.1186/s13063-020-04536-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/19/2020] [Indexed: 01/31/2023] Open
Abstract
Background With a survival rate of 6 to 11%, out-of-hospital cardiac arrest (OHCA) remains a healthcare challenge with room for improvement in morbidity and mortality. The guidelines emphasize the highest possible quality of cardiopulmonary resuscitation (CPR) and chest compressions (CC). It is essential to minimize CC interruptions, and therefore increase the chest compression fraction (CCF), as this is an independent factor for survival. Survival is significantly and positively correlated with the suitability of CCF targets, CC frequency, CC depth, and brief predefibrillation pause. CC guidance improves adherence to recommendations and allows closer alignment with the CC objectives. The possibility of improving CCF by lengthening the time between two CC relays and the effect of real-time feedback on the quality of the CC must be investigated. Methods Using a 2 × 2 factorial design in a multicenter randomized trial, two hypotheses will be tested simultaneously: (i) a 4-min relay rhythm improves the CCF (reducing the no-flow time) compared to the currently recommended 2-min relay rate, and (ii) a guiding tool improves the quality of CC. Primary outcomes (i) CCF and (ii) correct compression score will be recorded by a real-time feedback device. Five hundred adult nontraumatic OHCAs will be included over 2 years. Patients will be randomized in a 1:1:1:1 distribution receiving advanced CPR as follows: 2-min blind, 2 min with guidance, 4-min blind, or 4 min with guidance. Secondary outcomes are the depth, frequency, and release of CC; length (care, no-flow, and low-flow); rate of return of spontaneous circulation; characteristics of advanced CPR; survival at hospital admission; survival and neurological state on days 1 and 30 (or intensive care discharge); and dosage of neuron-specific enolase on days 1 and 3. Discussion This study will contribute to assessing the impact of real-time feedback on CC quality in practical conditions of OHCA resuscitation. It will also provide insight into the feasibility of extending the relay rhythm between two rescuers from the currently recommended 2 to 4 min. Trial registration ClinicalTrials.gov, NCT03817892. Registered on 28 January 2019
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Affiliation(s)
- Clément Buléon
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France.
| | - Jean-Jacques Parienti
- UNICAEN, CHU de Caen Normandie, Unité de Biostatistiques et de Recherche Clinique, Normandie University, 14000, Caen, France
| | - Elodie Morilland-Lecoq
- UNICAEN, CHU de Caen Normandie, Unité de Biostatistiques et de Recherche Clinique, Normandie University, 14000, Caen, France
| | - Laurent Halbout
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France
| | - Eric Cesaréo
- Department of Emergency Medicine, SAMU 69, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Pierre-Yves Dubien
- Department of Emergency Medicine, SAMU 69, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Benoit Jardel
- Department of Anaesthesiology and Intensive Care, SAMU 76, Rouen University Hospital, Rouen Cedex, France
| | | | - Kévin Husson
- Emergency Medicine Department and SAMU 59, Lille University Hospital, Lille, France
| | | | - Xavier Benet
- Emergency Department, Centre Hospitalier du Havre, Le Havre, France
| | | | - Antoine Aubrion
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France.,Emergency Department, Centre Hospitalier de Lisieux, Lisieux, France
| | - Catalin Muntean
- Emergency Department, Centre Hospitalier de Cherbourg, Cherbourg, France
| | - Erwan Dupire
- Emergency Department, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Eric Roupie
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France
| | - Hervé Hubert
- University Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000, Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre Électronique des Arrêts Cardiaques, Lille, France
| | - Christian Vilhelm
- University Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000, Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre Électronique des Arrêts Cardiaques, Lille, France
| | - Pierre-Yves Gueugniaud
- Department of Anaesthesiology and Intensive Care, SAMU 76, Rouen University Hospital, Rouen Cedex, France.,French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre Électronique des Arrêts Cardiaques, Lille, France
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Vaillancourt C, Petersen A, Meier EN, Christenson J, Menegazzi JJ, Aufderheide TP, Nichol G, Berg R, Callaway CW, Idris AH, Davis D, Fowler R, Egan D, Andrusiek D, Buick JE, Bishop TJ, Colella MR, Sahni R, Stiell IG, Cheskes S. The impact of increased chest compression fraction on survival for out-of-hospital cardiac arrest patients with a non-shockable initial rhythm. Resuscitation 2020; 154:93-100. [PMID: 32574654 DOI: 10.1016/j.resuscitation.2020.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/06/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We evaluated the effect of chest compression fraction (CCF) on survival to hospital discharge and return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythms. METHODS This is a retrospective analysis (completed in 2016) of a prospective cohort study which included OHCA patients from ten U.S. and Canadian sites (Resuscitation Outcomes Consortium Epistry and PRIMED study (2007-2011)). We included all OHCA victims of presumed cardiac aetiology, not witnessed by emergency medical services (EMS), without automated external defibrillator shock prior to EMS arrival, receiving > 1 min of CPR with CPR process measures available, and initial non-shockable rhythm. We measured CCF using the first 5 min of electronic CPR records. RESULTS Demographics of 12,928 adult patients were: mean age 68; male 59.9%; public location 8.5%; bystander witnessed 35.2%; bystander CPR 39.3%; median interval from 911 to defibrillator turned on 10 min:04 s; initial rhythm asystole 64.8%, PEA 26.0%, other non-shockable 9.2%; compression rate 80-120/min (69.1%); median CCF 74%; ROSC 25.6%; survival to hospital discharge 2.4%. Adjusted odds ratio (OR); 95% confidence intervals (95%CI) of survival for each CCF category were: 0-40% (2.00; 1.16, 3.32); 41-60% (0.83; 0.54, 1.24); 61-80% (1.02; 0.77, 1.35); and 81-100% (reference group). Adjusted (OR; 95%CI) of ROSC for each CCF category were: 0-40% (1.02; 0.79, 1.30); 41-60% (0.83; 0.72, 0.95); 61-80% (0.85; 0.77, 0.94); and 81-100% (reference group). CONCLUSIONS We observed an incremental benefit from higher CCF on the incidence of ROSC, but not survival, among non-shockable OHCA patients with CCF higher than 40%.
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Affiliation(s)
- Christian Vaillancourt
- Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada.
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, US
| | - Eric N Meier
- Department of Biostatistics, University of Washington, Seattle, WA, US
| | | | | | | | | | - Robert Berg
- University of Pennsylvania, The Children's Hospital of Philadelphia, PA, US
| | | | - Ahamed H Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, US
| | - Daniel Davis
- Air Methods Corporation, Greenwood Village, CO, US
| | - Raymond Fowler
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, US
| | - Debra Egan
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, US
| | | | - Jason E Buick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - T J Bishop
- Lake Chelan Community Hospital EMS, Chelan, WA, US
| | - M Riccardo Colella
- Departments of Emergency Medicine, Pediatrics and the Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, US
| | - Ritu Sahni
- Clackamas County EMS, Oregon City, OR, US
| | - Ian G Stiell
- Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Sheldon Cheskes
- Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
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19
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20
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Loaec M, Himebauch AS, Kilbaugh TJ, Berg RA, Graham K, Hanna R, Wolfe HA, Sutton RM, Morgan RW. Pediatric cardiopulmonary resuscitation quality during intra-hospital transport. Resuscitation 2020; 152:123-130. [PMID: 32422246 DOI: 10.1016/j.resuscitation.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
Abstract
AIM To evaluate pediatric cardiopulmonary resuscitation (CPR) quality during intra-hospital transport to facilitate extracorporeal membrane oxygenation (ECMO)-CPR (ECPR). We compared chest compression (CC) rate, depth, and fraction (CCF) between the pre-transport and intra-transport periods. METHODS Observational study of children <18 years with either in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) who underwent transport between two care locations within the hospital for ECPR and who had CPR mechanics data available. Descriptive patient and arrest characteristics were summarized. The primary analysis compared pre- to intra-transport CC rate, depth, and fraction. A secondary analysis compared the proportion of pre- versus intra-transport 60-s epochs meeting guideline recommendations for rate (100-120/min), depth (≥4 cm for infants; ≥5 cm for children ≥1 year), and CCF (≥0.80). RESULTS Seven patients (four IHCA; three witnessed OHCA) met eligibility criteria. Six (86%) patients survived the event and two (28%) survived to hospital discharge. Median transport CPR duration was 7 [IQR 5.5, 8.5] minutes. There were no differences in pre- vs. intra-transport CC rate (115 [113, 118] vs. 118 [114, 127] CCs/minute; p = 0.18), depth (3.2 [2.7, 4.4] vs. 3.6 [2.5, 4.6] cm; p = 0.50), or CCF (0.89 [0.82, 0.90] vs. 0.92 [0.79, 0.97]; p = 0.31). Equivalent proportions of 60-s CPR epochs met guideline recommendations between pre- and intra-transport (rate: 66% vs. 57% [p = 0.22]; depth: 14% vs. 19% [p = 0.39]; CCF: 80% vs. 75% [p = 0.43]). CONCLUSIONS Pediatric CPR quality was maintained during intra-hospital patient transport, suggesting that it is reasonable for ECPR systems to incorporate patient transport to facilitate ECMO cannulation.
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Affiliation(s)
- Morgann Loaec
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Kathryn Graham
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Richard Hanna
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Heather A Wolfe
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
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Cardiac arrest without pulse checks. Resuscitation 2020; 147:112-113. [DOI: 10.1016/j.resuscitation.2019.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
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Lauridsen KG, Watanabe I, Løfgren B, Cheng A, Duval-Arnould J, Hunt EA, Good GL, Niles D, Berg RA, Nishisaki A, Nadkarni VM. Standardising communication to improve in-hospital cardiopulmonary resuscitation. Resuscitation 2019; 147:73-80. [PMID: 31891790 DOI: 10.1016/j.resuscitation.2019.12.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 11/25/2022]
Abstract
AIM Recommendations for standardised communication to reduce chest compression (CC) pauses are lacking. We aimed to achieve consensus and evaluate feasibility and efficacy using standardised communication during cardiopulmonary resuscitation (CPR) events. METHODS Modified Delphi consensus process to design standardised communication elements. Feasibility was pilot tested in 16 simulated CPR scenarios (8 scenarios with physician team leaders and 8 with chest compressors) randomized (1:1) to standardised [INTERVENTION] vs. closed-loop communication [CONTROL]. Adherence and efficacy (duration of CC pauses for defibrillation, intubation, rhythm check) was assessed by audiovisual recording. Mental demand and frustration were assessed by NASA task load index subscales. RESULTS Consensus elements for standardised communication included: 1) team preparation 15-30 s before CC interruption, 2) pre-interruption countdown synchronized with last 5 CCs, 3) specific action words for defibrillation, intubation, and interrupting/resuming CCs. Median (Q1,Q3) adherence to standardised phrases was 98% (80%,100%). Efficacy analysis showed a median [Q1,Q3] peri-shock pause of 5.1 s. [4.4; 5.8] vs. 7.5 s. [6.3; 8.8] seconds, p < 0.001, intubation pause of 3.8 s. [3.6; 5.0] vs. 6.9 s. [4.8; 10.1] seconds, p = 0.03, rhythm check pause of 4.2 [3.2,5.7] vs. 8.6 [5.0,10.5] seconds, p < 0.001, median frustration index of 10/100 [5,20] vs. 35/100 [25,50], p < 0.001, and median mental demand load of 55/100 [30,70] vs. 65/100 [50,85], p = 0.41 for standardised vs. closed loop communication. CONCLUSION This pilot study demonstrated feasibility of using consensus-based standardised communication that was associated with shorter CC pauses for defibrillation, intubation, and rhythm checks without increasing frustration index or mental demand compared to current best practice, closed loop communication.
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Affiliation(s)
- Kasper Glerup Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Internal Medicine, Randers Regional Hospital, Denmark; Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA.
| | - Ichiro Watanabe
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Internal Medicine, Randers Regional Hospital, Denmark; Department of Cardiology, Aarhus University Hospital, USA
| | - Adam Cheng
- Department of Pediatrics, Cumming School of Medicine, University of Calgary
| | - Jordan Duval-Arnould
- Simulation Center, Johns Hopkins Medicine, Johns Hopkins University Hospital, USA
| | - Elizabeth A Hunt
- Simulation Center, Johns Hopkins Medicine, Johns Hopkins University Hospital, USA; Division of Health Informatics, Johns Hopkins University Hospital, Johns Hopkins Pediatric Hospital, USA; Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Grace L Good
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA
| | - Dana Niles
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA
| | - Akira Nishisaki
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA
| | - Vinay M Nadkarni
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA
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Sanson G, Ristagno G, Caggegi GD, Patsoura A, Xu V, Zambon M, Montalbano D, Vukanovic S, Antonaglia V. Impact of 'synchronous' and 'asynchronous' CPR modality on quality bundles and outcome in out-of-hospital cardiac arrest patients. Intern Emerg Med 2019; 14:1129-1137. [PMID: 31273676 DOI: 10.1007/s11739-019-02138-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022]
Abstract
During cardiopulmonary resuscitation (CPR), the need to interrupt chest compressions to provide synchronous ventilations prevents blood flow continuity, reducing the possibility to ensure high-quality CPR bundles of care and, thus, having a potentially negative impact on perfusion and patient outcome. Contemporaneous asynchronous chest compressions and ventilations may avoid these potentially negative effects. Only a few studies measured the CPR quality metrics during synchronous and asynchronous CPR modality and its relation to patient outcome. A prospective observational study was conducted on 285 consecutive adult patients with out-of-hospital cardiac arrest treated by EMS teams over a 30-month period. Ventilation rate, chest compression fraction (i.e. cardiac arrest time spent delivering uninterrupted chest compressions compared to total cardiac arrest time) and chest compression rate per minute were collected in real time by defibrillators and analysed through a dedicated software (electrical cardiac activity through the ECG, chest compression and ventilations through the transthoracic impedance) during synchronous and asynchronous CPR modalities. During asynchronous CPR modality, higher ventilation rate and chest compression fraction (p < 0.001), and lower chest compression rate per minute (p < 0.001) were ensured, being all cited metrics more adherent to the high-quality CPR bundles. Ventilation rate provided during the whole CPR was an independent predictor for a good neurological outcome (OR 3.795, p = 0.005). Asynchronous chest compression and ventilation ensured the most adequate chest compression fraction, uninterrupted chest compression rate and ventilation rate.
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Affiliation(s)
- Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
| | - Giuseppe Ristagno
- Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156, Milan, Italy
| | - Giuseppe Davide Caggegi
- Emergency Medical Service, Azienda Sanitaria Universitaria Integrata, Via Giovanni Sai 1-3, 34128, Trieste, Italy
| | - Athina Patsoura
- School of Medicine, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Veronica Xu
- School of Nursing, University of Trieste, Piazzale Valmaura 9, 34100, Trieste, Italy
| | - Marco Zambon
- Emergency Medical Service, Azienda Sanitaria Universitaria Integrata, Via Giovanni Sai 1-3, 34128, Trieste, Italy
| | - Domenico Montalbano
- Emergency Medical Service, Azienda Sanitaria Universitaria Integrata, Via Giovanni Sai 1-3, 34128, Trieste, Italy
| | - Sreten Vukanovic
- Emergency Medical Service, Azienda Sanitaria Universitaria Integrata, Via Giovanni Sai 1-3, 34128, Trieste, Italy
| | - Vittorio Antonaglia
- Regional Emergency Medical Service System, Azienda Regionale di Coordinamento per la Salute, via Pozzuolo, 330, 33057, Udine, Italy
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Teeter W, Romagnoli A, Wasicek P, Hu P, Yang S, Stein D, Scalea T, Brenner M. Resuscitative Endovascular Balloon Occlusion of the Aorta Improves Cardiac Compression Fraction Versus Resuscitative Thoracotomy in Patients in Traumatic Arrest. Ann Emerg Med 2019; 72:354-360. [PMID: 29685373 DOI: 10.1016/j.annemergmed.2018.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/09/2018] [Accepted: 02/15/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE Resuscitative endovascular balloon occlusion of the aorta (REBOA) is emerging as an alternative to resuscitative thoracotomy for proximal aortic control in select patients with exsanguinating hemorrhage below the diaphragm. The purpose of this study is to compare interruptions in closed chest compression or open chest cardiac massage during REBOA versus resuscitative thoracotomy. METHODS From May 2014 to December 2016, patients in arrest who received aortic occlusion with REBOA or resuscitative thoracotomy were included. Total cardiac compression time was defined as the total time that closed chest compression was performed for REBOA patients and the total time that closed chest compression (before resuscitative thoracotomy) and open chest cardiac massage (after thoracotomy) were performed for resuscitative thoracotomy patients. Cardiac compression fraction was defined as the time compressions occurred during the entire resuscitation phase. All resuscitations were captured by multiview, time-stamped videography. RESULTS Fifty patients with aortic occlusion after arrest were enrolled: 22 REBOA and 28 resuscitative thoracotomy. Most were men (86%) (median age 30.2 years, interquartile range [IQR] 24.9 to 42.3; median Injury Severity Score 27, IQR 16 to 42; neither differed between groups). The median duration of total cardiac compression time was 945 seconds (IQR 697 to 1,357) for REBOA versus 496 seconds (IQR 375 to 933) for resuscitative thoracotomy. During initial resuscitation, compressions occurred 86.5% of the time (SD 9.7%) during resuscitation with REBOA versus 35.7% of the time (SD 16.4%) in patients receiving resuscitative thoracotomy. Cardiac compression fraction improved after open cross clamp in resuscitative thoracotomy patients to 73.2% of the time (SD 18.0%) but remained significantly less than the same period for REBOA (86.7%; SD 9.4%). Mean cardiac compression fraction for REBOA was significantly improved over that for resuscitative thoracotomy (86.2% [SD 9.1%] versus 55.3 [SD 17.1%]; mean difference 31.0%; 95% confidence interval for difference 22.7% to 39.23%; P<.001). Median pause in resuscitation related to procedural tasks was 0 seconds (IQR 0 to 13) for REBOA and 148 seconds (IQR 118 to 223) in resuscitative thoracotomy. CONCLUSION Total duration of interruptions of cardiac compressions is shorter for patients receiving REBOA versus resuscitative thoracotomy before and during resuscitation with aortic occlusion. Markers for perfusion during resuscitation must be examined to understand the effects of cardiac compressions and aortic occlusion on patients in arrest because of hemorrhagic shock.
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Affiliation(s)
- William Teeter
- Department of Trauma and Surgical Critical Care, University of Maryland Medical System/R Adams Cowley Shock Trauma, Baltimore, MD.
| | - Anna Romagnoli
- Department of Trauma and Surgical Critical Care, University of Maryland Medical System/R Adams Cowley Shock Trauma, Baltimore, MD
| | - Philip Wasicek
- Department of Trauma and Surgical Critical Care, University of Maryland Medical System/R Adams Cowley Shock Trauma, Baltimore, MD
| | - Peter Hu
- Department of Trauma and Surgical Critical Care, University of Maryland Medical System/R Adams Cowley Shock Trauma, Baltimore, MD; Shock Trauma and Anesthesiology Research Center, University of Maryland, School of Medicine, Baltimore, MD
| | - Shiming Yang
- Department of Trauma and Surgical Critical Care, University of Maryland Medical System/R Adams Cowley Shock Trauma, Baltimore, MD; Shock Trauma and Anesthesiology Research Center, University of Maryland, School of Medicine, Baltimore, MD
| | - Deborah Stein
- Department of Trauma and Surgical Critical Care, University of Maryland Medical System/R Adams Cowley Shock Trauma, Baltimore, MD
| | - Thomas Scalea
- Department of Trauma and Surgical Critical Care, University of Maryland Medical System/R Adams Cowley Shock Trauma, Baltimore, MD
| | - Megan Brenner
- Department of Trauma and Surgical Critical Care, University of Maryland Medical System/R Adams Cowley Shock Trauma, Baltimore, MD
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Antonaglia V, Pegani C, Caggegi GD, Patsoura A, Xu V, Zambon M, Sanson G. Impact of Transitory ROSC Events on Neurological Outcome in Patients with Out-of-Hospital Cardiac Arrest. J Clin Med 2019; 8:jcm8070926. [PMID: 31252641 PMCID: PMC6678170 DOI: 10.3390/jcm8070926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022] Open
Abstract
In out-of-hospital cardiac arrest (OHCA), the occurrence of temporary periods of return to spontaneous circulation (t-ROSC) has been found to be predictive of survival to hospital discharge. The relationship between the duration of t-ROSCs and OHCA outcome has not been explored yet. The aim of this prospective observational study was to analyze the duration of t-ROSCs during OHCA and its impact on outcome. Defibrillator-recorded OHCA events were analyzed via dedicated software. The number of t-ROSC episodes and their overall durations were recorded. The study endpoint was the good neurologic outcome at hospital discharge. Among 285 patients included in the study, 45 (15.8%) had one or more t-ROSCs. The likelihood of t-ROSC occurrence was higher in patients with a shockable rhythm (p = 0.009). The cumulative length of t-ROSC episodes was significantly higher for patients who achieved sustained ROSC (p < 0.001). The adjusted cumulative t-ROSC length was an independent predictor for good neurological outcome at hospital discharge (OR 1.588, 95% CI 1.017 to 2.481; p = 0.042). According to our findings and data from previous studies, t-ROSC episodes during OHCA should be considered as a favorable prognostic factor, encouraging continuing resuscitative efforts.
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Affiliation(s)
- Vittorio Antonaglia
- Regional Emergency Medical Service System, Azienda Regionale Coordinamento della Salute, 33057 Udine, Italy
| | - Carlo Pegani
- Regional Emergency Medical Service System, Azienda Regionale Coordinamento della Salute, 33057 Udine, Italy
| | - Giuseppe Davide Caggegi
- Emergency Medical Service System, Azienda Sanitaria Universitaria Integrata, 734128 Trieste, Italy
| | - Athina Patsoura
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, School of Medicine, University of Verona, 837129 Verona, Italy
| | - Veronica Xu
- Azienda USL Toscana Sud Est, 54-52100 Arezzo, Italy
| | - Marco Zambon
- Emergency Medical Service System, Azienda Sanitaria Universitaria Integrata, 734128 Trieste, Italy
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 9-34100 Piazzale Europa, Italy.
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Effects of Chest Compression Fraction on Return of Spontaneous Circulation in Patients with Cardiac Arrest; a Brief Report. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 4:e8. [PMID: 31938777 PMCID: PMC6955024 DOI: 10.22114/ajem.v0i0.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: The association between chest compression fraction (CCF) and return of spontaneous circulation (ROSC)has been a controversial issue in literature; and both positive and negative correlations have been reported between CCF and survival rate. Objective: The present study was conducted to determine the relationship between the rate and outcomes of chest compression and between CCF and ROSC in patients with cardiac arrest. Method: The present prospective observational study was conducted during 2018 on patients with cardiac arrest aged 18–80 years. Participants with end-stage renal diseases, malignancies and grade IV heart failure were excluded. A stop watch was set upon the occurrence of a code blue in the emergency department, and time was recorded by the observer upon the arrival of the code blue team leader (a maximum permissible duration of 10 minutes). The interruptions in chest compressions were recorded using a stopwatch, and CCF was calculated by dividing the duration of chest compression by the total duration of cardiac arrest observed. Results: Totally, 45 participants were enrolled. Most of the patients had non-shockable rhythms and underwent CPR based on related algorithm. Hypoxia and hypovolemia were the two probable etiology of cardiac arrest; and coronary artery disease was the most prevalent underlying disease. All patients with ROSC had CCF more than 70%. A CCF below 70% was observed in 21 cases (46.7%), and a fraction of at least 70% in 24 cases. All patients with ROSC had CCF more than 70%. A CCF below 70% was observed in 21 cases (46.7%), and a fraction of at least 70% in 24. A significantly higher duration and fraction of chest compression was observed in the participants who attained ROSC (P<0.001). Conclusion: Based on the findings of current study, it seems that significantly higher chest compression durations and fractions were found to be associated with ROSC, which was achieved in the majority of the participants with a CCF of at least 80%.
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Morgan RW, Landis WP, Marquez A, Graham K, Roberts AL, Lauridsen KG, Wolfe HA, Nadkarni VM, Topjian AA, Berg RA, Kilbaugh TJ, Sutton RM. Hemodynamic effects of chest compression interruptions during pediatric in-hospital cardiopulmonary resuscitation. Resuscitation 2019; 139:1-8. [PMID: 30946924 DOI: 10.1016/j.resuscitation.2019.03.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
Abstract
AIM Animal studies have established deleterious hemodynamic effects of interrupting chest compressions. The objective of this study was to evaluate the effect of interruptions on invasively measured blood pressures (BPs) during pediatric in-hospital cardiac arrest (IHCA). METHODS This was a single-center, observational study of pediatric (<18 years) intensive care unit IHCAs in patients with invasive arterial catheters in place. Interruptions were defined as ≥1 s between chest compressions. Diastolic BP (DBP) and systolic BP (SBP) were determined for individual compressions. For the primary analysis, the average DBP and SBP of the 20 compressions preceding each interruption were compared to the average DBP and SBP of the first 20 compressions following each interruption utilizing non-parametric paired analyses. Linear regression evaluated the change in DBP during interruptions and following interruptions. RESULTS Thirty-two IHCA events met inclusion criteria, yielding 161 evaluable interruptions. The median age was 2.1 years. Return of circulation was achieved in 24 (75%). The median interruption duration was 2.4 [1.4, 7.0] seconds. Most patients were intubated pre-arrest and received epinephrine during CPR. BPs were not different pre- vs. post-interruption (DBP: 28.7 [21.6, 38.2] vs. 28.3 [21.0, 37.4] mmHg, p = 0.81; SBP: 82.0 [51.7, 116.7] vs. 85.4 [55.7, 122.2] mmHg, p = 0.07). DBP decreased 8.41 ± 0.73 mmHg (p < 0.001) during the first second of interruptions and 0.19 ± 0.02 mmHg/s (p < 0.001) in subsequent seconds. CONCLUSIONS BPs following chest compression interruptions did not differ from pre-interruption BPs. These findings suggest that in the setting of high-quality in-hospital CPR, brief chest compression interruptions do not have persistent detrimental hemodynamic impact.
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Affiliation(s)
- Ryan W Morgan
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States.
| | - William P Landis
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Alexandra Marquez
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Kathryn Graham
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Anna L Roberts
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Kasper G Lauridsen
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Heather A Wolfe
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Vinay M Nadkarni
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Alexis A Topjian
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Robert A Berg
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Todd J Kilbaugh
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Robert M Sutton
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
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Abstract
BACKGROUND Adrenaline and vasopressin are widely used to treat people with cardiac arrest, but there is uncertainty about the safety, effectiveness and the optimal dose. OBJECTIVES To determine whether adrenaline or vasopressin, or both, administered during cardiac arrest, afford any survival benefit. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and DARE from their inception to 8 May 2018, and the International Liaison Committee on Resuscitation 2015 Advanced Life Support Consensus on Science and Treatment Recommendations. We also searched four trial registers on 5 September 2018 and checked the reference lists of the included studies and review papers to identify potential papers for review. SELECTION CRITERIA Any randomised controlled trial comparing: standard-dose adrenaline versus placebo; standard-dose adrenaline versus high-dose adrenaline; and adrenaline versus vasopressin, in any setting, due to any cause of cardiac arrest, in adults and children. There were no language restrictions. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials for review, assessed risks of bias and extracted data, resolving disagreements through re-examination of the trial reports and by discussion. We used risk ratios (RRs) with 95% confidence intervals (CIs) to compare dichotomous outcomes for clinical events. There were no continuous outcomes reported. We examined groups of trials for heterogeneity. We report the quality of evidence for each outcome, using the GRADE approach. MAIN RESULTS We included 26 studies (21,704 participants).Moderate-quality evidence found that adrenaline increased survival to hospital discharge compared to placebo (RR 1.44, 95% CI 1.11 to 1.86; 2 studies, 8538 participants; an increase from 23 to 32 per 1000, 95% CI 25 to 42). We are uncertain about survival to hospital discharge for high-dose compared to standard-dose adrenaline (RR 1.10, 95% CI 0.75 to 1.62; participants = 6274; studies = 10); an increase from 33 to 36 per 1000, 95% CI 24 to 53); standard-dose adrenaline versus vasopressin (RR 1.25, 95% CI 0.84 to 1.85; 6 studies; 2511 participants; an increase from 72 to 90 per 1000, 95% CI 60 to 133); and standard-dose adrenaline versus vasopressin plus adrenaline (RR 0.76, 95% CI 0.47 to 1.22; 3 studies; 3242 participants; a possible decrease from 24 to 18 per 1000, 95% CI 11 to 29), due to very low-quality evidence.Moderate-quality evidence found that adrenaline compared with placebo increased survival to hospital admission (RR 2.51, 95% CI 1.67 to 3.76; 2 studies, 8489 participants; an increase from 83 to 209 per 1000, 95% CI 139 to 313). We are uncertain about survival to hospital admission when comparing standard-dose with high-dose adrenaline, due to very low-quality evidence. Vasopressin may improve survival to hospital admission when compared with standard-dose adrenaline (RR 1.27, 95% CI 1.04 to 1.54; 3 studies, 1953 participants; low-quality evidence; an increase from 260 to 330 per 1000, 95% CI 270 to 400), and may make little or no difference when compared to standard-dose adrenaline plus vasopressin (RR 0.95, 95% CI 0.83 to 1.08; 3 studies; 3249 participants; low-quality evidence; a decrease from 218 to 207 per 1000 (95% CI 181 to 236).There was no evidence that adrenaline (any dose) or vasopressin improved neurological outcomes.The rate of return of spontaneous circulation (ROSC) was higher for standard-dose adrenaline versus placebo (RR 2.86, 95% CI 2.21 to 3.71; participants = 8663; studies = 3); moderate-quality evidence; an increase from 115 to 329 per 1000, 95% CI 254 to 427). We are uncertain about the effect on ROSC for the comparison of standard-dose versus high-dose adrenaline and standard-does adrenaline compared to vasopressin, due to very low-quality evidence. Standard-dose adrenaline may make little or no difference to ROSC when compared to standard-dose adrenaline plus vasopressin (RR 0.97, 95% CI 0.87 to 1.08; 3 studies, 3249 participants; low-quality evidence; a possible decrease from 299 to 290 per 1000, 95% CI 260 to 323).The source of funding was not stated in 11 of the 26 studies. The study drugs were provided by the manufacturer in four of the 26 studies, but neither drug represents a profitable commercial option. The other 11 studies were funded by organisations such as research foundations and government funding bodies. AUTHORS' CONCLUSIONS This review provides moderate-quality evidence that standard-dose adrenaline compared to placebo improves return of spontaneous circulation, survival to hospital admission and survival to hospital discharge, but low-quality evidence that it did not affect survival with a favourable neurological outcome. Very low -quality evidence found that high-dose adrenaline compared to standard-dose adrenaline improved return of spontaneous circulation and survival to admission. Vasopressin compared to standard dose adrenaline improved survival to admission but not return of spontaneous circulation, whilst the combination of adrenaline and vasopressin compared with adrenaline alone had no effect on these outcomes. Neither standard dose adrenaline, high-dose adrenaline,vasopressin nor a combination of adrenaline and vasopressin improved survival with a favourable neurological outcome. Many of these studies were conducted more than 20 years ago. Treatment has changed in recent years, so the findings from older studies may not reflect current practice.
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Affiliation(s)
- Judith Finn
- Curtin UniversityPrehospital, Resuscitation and Emergency Care Research Unit (PRECRU)Kent StreetBentleyWestern AustraliaAustralia6102
- St John Ambulance Western AustraliaBelmontAustralia
| | - Ian Jacobs
- Curtin UniversityPrehospital, Resuscitation and Emergency Care Research Unit (PRECRU)Kent StreetBentleyWestern AustraliaAustralia6102
- St John Ambulance Western AustraliaBelmontAustralia
| | | | - Simon Gates
- University of BirminghamCancer Research UK Clinical Trials Unit, School of Cancer Sciences, Institute of Cancer and Genomic SciencesBirminghamUKB15 2TT
| | - Gavin D Perkins
- University of WarwickWarwick Medical School and University Hospitals BirminghamCoventryUK
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Heegeman DJ, Rosandick WD, Boehning-Anderson RH, Woltmann AR. Supraglottic airway device placement by respiratory therapists. Am J Emerg Med 2018; 36:1845-1848. [PMID: 30097274 DOI: 10.1016/j.ajem.2018.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Respiratory Therapists (RTs) are some of the first staff to arrive at in-hospital incidents where cardiopulmonary resuscitation (CPR) is needed, yet at some facilities, their ability to intubate is limited by hospital scope of practice. During the intubation process, CPR is often interrupted which could potentially increase the likelihood of adverse patient outcomes. Training RTs to secure the airway using non-intubation methods may reduce or eliminate time for CPR interruptions and allow for earlier continuous/uninterrupted chest compressions. DESIGN A pilot study was developed to assess the effectiveness of a new policy for RT scope of practice. METHODS RTs were trained for supraglottic airway device placement prior to procedure initiation. After each device insertion event, RTs completed a written survey. Time between cardiac arrest and device insertion, number of insertion attempts, ease of placement, technical specifications of the device, complications, and survival were compiled and compared between supraglottic airway device and endotracheal tube (ETT) placement. RESULTS Procedural information from 23 patients who received a supraglottic airway device during the trial was compared to retrospective data of CPR events requiring intubation from the previous year. Time between initiation of cardiac arrest and advanced airway placement decreased significantly (p < 0.0001) when RTs placed the supraglottic airway device (4.7 min) versus ETT at CPR events the previous year (8.6 min). Device-associated complications were minimal and patient mortality was the same regardless of device. CONCLUSION We propose that more RTs should be trained to insert supraglottic airway devices during inpatient CPR events.
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Affiliation(s)
- David J Heegeman
- Emergency Department, Marshfield Medical Center, 611 Saint Joseph's Avenue, Marshfield, WI 54449, USA.
| | - William D Rosandick
- Emergency Department, Marshfield Medical Center, 611 Saint Joseph's Avenue, Marshfield, WI 54449, USA
| | | | - Andrew R Woltmann
- Emergency Department, Marshfield Medical Center, 611 Saint Joseph's Avenue, Marshfield, WI 54449, USA
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Fumagalli F, Silver AE, Tan Q, Zaidi N, Ristagno G. Cardiac rhythm analysis during ongoing cardiopulmonary resuscitation using the Analysis During Compressions with Fast Reconfirmation technology. Heart Rhythm 2018; 15:248-255. [DOI: 10.1016/j.hrthm.2017.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Indexed: 11/25/2022]
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Talikowska M, Tohira H, Inoue M, Bailey P, Brink D, Finn J. Lower chest compression fraction associated with ROSC in OHCA patients with longer downtimes. Resuscitation 2017; 116:60-65. [DOI: 10.1016/j.resuscitation.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/06/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
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Cheskes S, Schmicker RH, Rea T, Morrison LJ, Grunau B, Drennan IR, Leroux B, Vaillancourt C, Schmidt TA, Koller AC, Kudenchuk P, Aufderheide TP, Herren H, Flickinger KH, Charleston M, Straight R, Christenson J. The association between AHA CPR quality guideline compliance and clinical outcomes from out-of-hospital cardiac arrest. Resuscitation 2017; 116:39-45. [PMID: 28476474 DOI: 10.1016/j.resuscitation.2017.05.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/09/2017] [Accepted: 05/01/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Measures of chest compression fraction (CCF), compression rate, compression depth and pre-shock pause have all been independently associated with improved outcomes from out-of-hospital (OHCA) cardiac arrest. However, it is unknown whether compliance with American Heart Association (AHA) guidelines incorporating all the aforementioned metrics, is associated with improved survival from OHCA. METHODS We performed a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database. As per the 2015 American Heart Association (AHA) guidelines, guideline compliant cardiopulmonary resuscitation (CPR) was defined as CCF >0.8, chest compression rate 100-120/minute, chest compression depth 50-60mm, and pre-shock pause <10s. Multivariable logistic regression models controlling for Utstein variables were used to assess the relationship between global guideline compliance and survival to hospital discharge and neurologically intact survival with MRS ≤3. Due to potential confounding between CPR quality metrics and cases that achieved early ROSC, we performed an a priori subgroup analysis restricted to patients who obtained ROSC after ≥10min of EMS resuscitation. RESULTS After allowing for study exclusions, 19,568 defibrillator records were collected over a 4-year period ending in June 2015. For all reported models, the reference standard included all cases who did not meet all CPR quality benchmarks. For the primary model (CCF, rate, depth), there was no significant difference in survival for resuscitations that met all CPR quality benchmarks (guideline compliant) compared to the reference standard (OR 1.26; 95% CI: 0.80, 1.97). When the dataset was restricted to patients obtaining ROSC after ≥10min of EMS resuscitation (n=4,158), survival was significantly higher for those resuscitations that were guideline compliant (OR 2.17; 95% CI: 1.11, 4.27) compared to the reference standard. Similar findings were obtained for neurologically intact survival with MRS ≤3 (OR 3.03; 95% CI: 1.12, 8.20). CONCLUSIONS In this observational study, compliance with AHA guidelines for CPR quality was not associated with improved outcomes from OHCA. Conversely, when restricting the cohort to those with late ROSC, compliance with guidelines was associated with improved clinical outcomes. Strategies to improve overall guideline compliance may have a significant impact on outcomes from OHCA.
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Affiliation(s)
| | | | - Tom Rea
- University of Washington, Seattle, Washington, United States
| | | | - Brian Grunau
- University of British Columbia, Vancouver, British, Colombia
| | | | - Brian Leroux
- University of Washington, Seattle, Washington, United States
| | | | - Terri A Schmidt
- Oregon Health and Sciences University, Portland, Oregon, United States
| | - Allison C Koller
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Peter Kudenchuk
- University of Washington, Seattle, Washington, United States
| | | | - Heather Herren
- University of Washington, Seattle, Washington, United States
| | | | - Mark Charleston
- Tualatin Valley Fire & Rescue, Portland, Oregon, United States
| | - Ron Straight
- University of British Columbia, Vancouver, British, Colombia
| | - Jim Christenson
- University of British Columbia, Vancouver, British, Colombia
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Weston BW, Jasti J, Lerner EB, Szabo A, Aufderheide TP, Colella MR. Does an individualized feedback mechanism improve quality of out-of-hospital CPR? Resuscitation 2017; 113:96-100. [PMID: 28215590 DOI: 10.1016/j.resuscitation.2017.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/30/2017] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite its prevalence, survival from out-of-hospital cardiac arrest remains low. High quality CPR has been associated with improved survival in cardiac arrest patients. In early 2014, a program was initiated to provide feedback on CPR quality to prehospital providers after every treated cardiac arrest. OBJECTIVE To assess whether individualized CPR feedback was associated with improved CPR quality measures in the prehospital setting. METHODS This before and after retrospective review included all treated adult out-of-hospital cardiac arrest in patients in an urban community. Data was compared prior to and after the initiation of the CPR feedback program. We compared the percent of encounters reaching the system defined benchmarks as well as the average values for compression fraction, compression rate, compression depth, and pre-shock pause in the before period compared to the after period. RESULTS There were 159 encounters in the before period and 117 in the after. Compared to the before group, the after group had higher average compression rates (111.2/min vs 113.8/min; p=0.042), increased compression depths (4.9cm vs 5.6cm; p<0.001), and increased rates of benchmark achievement for compression depth greater than 5cm (48.1% vs 72.6%; p<0.001). No significant difference was noted in pre-shock pause (21.4s vs 14.7s; p=0.068). Additionally, no difference was noted between groups for compression fraction, though goal achievement was high in both groups. CONCLUSION We found that individual CPR feedback is associated with marginally improved quality of CPR in the prehospital setting. Further investigation with larger samples is warranted to better quantify this effect.
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Affiliation(s)
- B W Weston
- The Medical College of Wisconsin, United States.
| | - J Jasti
- The Medical College of Wisconsin, United States
| | - E B Lerner
- The Medical College of Wisconsin, United States
| | - A Szabo
- The Medical College of Wisconsin, United States
| | | | - M R Colella
- The Medical College of Wisconsin, United States
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Resuscitation highlights in 2016. Resuscitation 2017; 114:A1-A7. [PMID: 28212838 DOI: 10.1016/j.resuscitation.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/21/2022]
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